Post on 24-Jul-2020
Esther Erdei, Ph.D., M.P.H. M.Sc. Hons.University of New Mexico Health Sciences Center
College of Pharmacy - Community Environmental Health Program
Funding: Navajo Birth Cohort Study: CDC/NCEH/ATSDR:5U01TS000135-05
“unique need for tribal-focused research to identify impacts of pollution, dietary exposure, cumulative risk and climate change as well as to inform decisions to reduce health risks…” – US EPA, 2004
Land-based cultures Contact with their environment Historical and current presence of mining, oil and gas industry Reliance on natural resources for traditional diets, customs and
languages. Sovereign tribal governments – Tribal Institutional Review Board is a
governing body. Lack of culturally-centered primary research
Limited understanding about environmental contamination on public health. US EPA, 2004
Examples of different ways working with Tribal oversight and solving environmental health problems with Tribal stakeholders and communities Navajo Nation – largest Tribe of the USA, Southwestern US, in 4
states; > 300,000 enrolled Tribal members in 2010 Census, from those 187,600 live on the land surface area of the size of the State of West Virginia map
Cheyenne River Sioux Tribe – 4th largest Tribes of the USA, more than 19,900 people enrolled, land is located in South Dakota, spans across the geographic area of the State of Connecticut
Tribal environmental health research with Tribal stakeholders and communities Navajo Nation – abandoned uranium mining - structured Tribal Council oversight on ALL studies done in the
Navajo Nation- more than 270 active studies are ongoing
- Navajo Nation Human Research Review Board, elected 9 members of the Board representing Tribal educational, community, health/medical and cultural/anthropologic research interest and review
Navajo Nation Human Research Review Board
Study Protocol Approval Requirements
Quarterly Reports Annual Report & Continuation
Request Directly address community
benefits of research Reports on abstracts,
presentations, planned/invited lectures
Reporting of adverse events, unexpected changes to protocol
Manuscripts submitted before publication
Agreement on Material Transfers to other universities, collaborators
Data evaluation agreement – ASQs to establish Tribal-specific pediatric screening
Data sharing
Informed consent from the tribal governance as well as individual participants
Provide community-specific research-related information needed to make an informed decision
Assure community of prior endorsement, wider dissemination of the study objectives, methods and results.
WesternScientific > personal value
TraditionalBody & spirit an integral whole
Congressional committee outraged over Navajo uranium legacyBy Kathy Helms, Dine Bureau, Gallup Independent, Oct. 24, 2007
WINDOW ROCK – A picture may be worth a thousand words, but the sound of an instrument used to detect radioactive contamination, clicking away over a soil sample from Tuba City, set a federal oversight committee on its ear Wednesday during a hearing in Washington.
Chairman Henry Waxman’s Committee on Oversight and Government Reform heard from a Navajo Nation delegation about the health and environmental impacts of uranium contamination during a four-hour hearing.
Several congressional leaders expressed outrage at the federal government for allowing such
DiNEH Project
Navajo Birth Cohort Study
Research Responds to the Navajo Uranium Legacy
Growing in Beauty
(developmental disabilitieservices provider)
s
USEPA
Region 9
CDC / ATSDR
Navajo Area Indian Health Service
Navajo NationDepartment of Health
DiNEH Project Team
• UNM CEHP• UNM Pediatrics• UNM Center for Development and
Disability• Southwest Research and Information
Center (SRIC)• Tribal Consultants
Navajo
Birth CohortMothers, fathers & babies
community members; chapters
With Help From
PL93-638 Facilities(Tséhootsooí, Tuba City)
Other Navajo Nation Agencies
NN EPA, WIC, Health Education, Office of Uranium Workers
Navajo Birth Cohort Study Cooperating Organizations
NBCS Cohort Members
● 781 Mothers (27 years, range 14 - 45 yrs)
● 764 Babies ● 227 Dads (29 years, range
17 – 51 yrs )
● Younger generation of Navajos with no occupational U mining exposure
Our first participants, a couple living in Sheep Springs, NM, were enrolled through the Chinle Hospital in 2013.
Traditional Beliefs Giving away some personal samples may be contrary to
traditional norms.
To avoid such unintended conflicts, the collection of these biosamples should only be undertaken with honest and transparent risk/benefit evaluation conducted in collaboration with the tribal community.
Agreements made to co-monitor and openly communicate about study procedures.
Develop best practices for ethical exposure assessment in environmental health research.
Capacity building and environmental health education & improvement in health literacy
Blood Urine Meconium
Mother EnrollmentDelivery
EnrollmentDelivery
Father Enrollment Enrollment
Baby Birth (cord blood)2-6 months of age12 months of age
Birth2-6 months of age12 months of age
Birth
Biological sample collection in NBCS
Participant Report Back LettersBiomonitoring and micronutrients results of all 36 metals (CDC)
Mother (Enrollment) Mother and baby (Delivery) Baby (Birth to 12 months) Father’s letter (Enrollment) Include
Emphasis on 4 reportable metals (U, As, Hg & Pb)
Participant’s results Cohort ranges National range
50- 95% range of NHANES concentrations (2011-2012) – CDC Fourth Report
Participant Report Back LettersHome Environmental Assessment
Gamma radiation, indoor Rn 22 metals in dust Quality information of drinking water
sources used in the home Used in mapping of environmental
exposures across Navajo Nation Attachment of Letter - developed w/
field staff - FAQs about biomonitoring and metal exposure avoidance, list of abbreviation used in letters
Here comes picture of letter
Supporting participant, community and Navajo Area IHS involvement –
structured communication Participants can ask questions from
local, Indian Health Service Clinical Cohort Liaisons almost all of them speak Navajo, CEHP trained our field team and
clinical sites in several occasions on possible exposures to mine waste
1-800 phone line at CEHP Office is implemented to answer community/family members’ questions in Navajo
Navajo Area Indian Health Service medical providers (primary care physicians, midwives, nurses, surgery) receive regular updates and education
Navajo HIS health technicians and laboratory personnel also receive updates - increase their assistance in enrollment and follow-up of babies
The Homestake Mine in 1889 The Homestake Mine in 1986
Tribal environmental health research with Tribal stakeholders and communities Cheyenne River Sioux Tribe – mercury contamination related to
more than 900 gold and silver mines of the Black Hills 9 Lakota Nations are located in South and North Dakota collaborating with the federal Indian Health Service’s Great Plains
Institutional Review Board (Aberdeen, SD)
Apply and receive supportive CRST EXECUTIVE RESOLUTIONSNO. E-302-08-CR, E-134-2014-CR. –No per se IRB Board on CRST
Agreements to laboratory examinations, transport of materials involving third party labs, state entities
CRST was one of the FIRST Native Tribes to receive Environmental Justice grant from NIEHS (Lewis/ Henderson/Ducheneaux) in 2002; • participatory and community-based, empowered research
approach - Local Research Team: Missouri Breaks Industries Research Inc. (MBIRI)
• more organic development of ideas • Tribal Health Committee, 9 members, reporting and
presentations
Future Plans on CRST – Tribally-driven environmental health research agenda Identify critical pathways of environmental exposures –occupational
and recreational activities – necessary step for Tribal land development, new town building, to create Tribal businesses
Farming/ranching, community-level exposures to pesticides
Public health concerns of very high rates of active cigarette smoking, indoor exposures to chemicals
Addressing these problems w/ current and future grant applications
Questions?